الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Psoriasis is a common chronic skin disease, affecting approximately
1-3% of the world population. Nail psoriasis is recognized as a common manifestation of psoriasis, occurring from 15% to 79%of patients of psoriasis, with an estimated lifetime incidence of 80–90%.
Treatment options for nail psoriasis are different including, corticosteroids, vitamin D analogs, tazarotene, anthralin, 5 fluorouracil, retinoids, calcipotriol, and cyclosporin as a topical treatment, intralesional corticosteroids. Biological treatment such as infliximab, etanercept, alefacept, and adalimumab. Laser treatment as (PDT) photodynamic therapy, (PDL) pulsed dye laser, (IPL) intense pulsed light therapy, Excimer laser, Nd: YAG laser.
The PDL has been widely used in treating nail psoriasis due to the highly vascular nature of psoriatic lesions. The most commonly used wavelengths for PDL therapeutic use are 585 and 595 nm, which can effectively reach the nail bed through the nail plate.
The intense pulsed light works on the principle of selective photothermolysis to cause coagulation of the enlarged blood vessels that supply the psoriatic nail. The wavelengths for IPL therapeutic use are 550- to 1,200-nm, to reach the nail bed through the nail plate effectively.
Therefore, the aim of this study is to assess and compare the efficacy of PDL versus IPL laser as treatment modalities for nail psoriasis, as several studies showed different success rates of both PDL and IPL.
The presented study included twenty patients with clinically and dermoscopically diagnosed bilateral fingernail psoriasis. Patients were randomized into 3 groups; group A; psoriatic nails of one hand treated with PDL; group B; psoriatic nails of the opposite hand treated with IPL; and group C; the remaining 2 or 3 fingers with nail psoriasis left without treatment as a control group.
Dermoscopic examination of the nails using handheld dermoscope DermLite DL4 pocket was used to help in diagnosis and evaluation of the nail’s response with dry and wet dermoscopy. Digital clinical and dermoscopic photographs of nails were carried out before treatment (baseline), before the 3rd session, before the 5th session, and three months after the last session for evaluating the NAPSI score.
The results of the present study revealed that a significant reduction in the mean total NAPSI score, Target Napsi score, and Modified Napsi score from the baseline to the end of the study were observed in the PDL group as well as in the IPL group with no significant difference between the treated groups.
In addition, we observed that there was a significant improvement after treatment with no statistically significant difference between the nail bed and nail matrix in the treated groups.
Regarding the nail lesions, best and early improvement was seen in the matter of splinter hemorrhage and lunular erythema. Crumbling, oil drop, leukonychia, onycholysis and pitting were less markedly improved, while improvements in subungual hyperkeratosis were limited.
Subjective evaluation of nail response to treatment was assessed regarding the patient’s opinion concluding that there was a statistically significant difference from the 3rd session to 3 months after the last session denoting their improvement with no significant difference between both groups.
Pain was the adverse effect noticed during and after sessions. On evaluating the pain, we observed that IPL is more painful than PDL, with a higher mean pain score in IPL than in PDL with a significant difference.
DLQI 10 questionnaire answers showed significant improvement from the baseline to the last follow-up visit in both treated groups with no significant difference between them